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'LICATION FC SANT TION PES I Permit No. N� - - (Complete-in Duplicate) Date Issued .�1 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliant with County Ordinance No. 549. ��CAL0A,; LV JOB ADDRESS AND LOCATIO V /�_-- -�-tom. -- F -/QN QE zz Owner's Name _- ----- }}�� // Kp � L /�_. - PhoneQ37v6 Address-•----------•----FTI. -- l�N Y_79 0.AK.P.A.L- .r: - Contractor's Name- - ------ - - ---- ---------------------------• . ----- -------- ..................................-... Phone----•----------------- .---------- Installation will serve: Residence 23'—Apartment House E3Commercial E) Trailer Court [InMotel ❑ Other ❑ Number of living units: -_ 1_. Number of bedrooms - Number of baths _l-... Lot size ...................... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ------ - ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Q-�Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes date_.__.... .......- I No New Construction: Yes t No ❑ FHA/VA: Yes-RT--No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (� Septic T Distance from nearest well..-......5 Distance from foundation--------/Q..... Material No. of compartments-----..:Z-------------Size.�'X_L_V.X_5_-__Liquid depth......4 , -a Capacity---f-7--g-a. Disposal Field: Distance from nearest well..--. ----Distance from foundation.______. - / .�_Q..-.Distance to nearest lot line.___.... � Number of lines ..----------- .._..--.___-___---_.Length of each line.. ........._ .._0....___.Width of trench..-._ -•-•- �� ^ Type of filter material___. - .�- K.---Depth of filter material-----�9_.._._...Total length-_-._.._._�Q Seepage Pit: Distance to nearest well----10-0-----Distance,-from foundation._.__ . f••� 16------ Distance to nearest lot line--�_..._.... � ❑ Number of pits_. ----f........... Lining material. .. ACA..--- Size: Diameter..�.x Cesspool: Distance from nearest well ----------------Distance from foundation---.-.-.--------- ..Lining material-----:................__.-_-__--_.-_- ❑ Size: Diameter- -- ---- --- ----- ----_--------.Depth................................. - -------- ------Liquid Capacity ....._ al s. Privy: Distance from nearest well ------------------ _---___._.._Distance from nearest building-. ❑ Distance to nearest lot line ----------------------------------------------------------------- Remodeling ---Remodeling and/or repairing (describe):...................................................... ................................................ -------------------............................................................................................ ----------------------------------------------------------------------------------------------------- •------------------------------_---- ----------------........................................................... 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a d �andegulafions of the San Joaquin Local Health District. (Signed) - �. c - - -- - --- --------- - ---------- _. .(Owner and/or Contractor) By:------------------------------- ---------- - ------_ ------ ---------------------- ------------------------------------- the r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---. t. '•d------------... ._ ------- -- --- DATE--------,7 +7` � - REVIEWEDBY--------------------------------------------- ----------------------•----------- -------- - ------ ------- ------ DATE .....•-•----.... -------------- UILDINGPERMIT ISSUED....-... - ..................................................--------------------------------------- DA•TE--------••-•-------•-------------------------------- -----•--•-----•---•------. _-_. Alterations and/or recommendations:.......................... _..._...._...._ ----•- ................................................... - -•-------••----•-------•--•-•----•------------•------•--...-•••--•................•.._...........--•-----..........-•-••----•------- ---------•--•-•-----•-•----•-----•---......-•---.•---••---•--•----.--•-•------------------•-•--••-•-•--•--•--- Li FINAL I N S P QR Date... .................7---# - / ... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi California Manteca,California Tracy,California E.H.92M 1-67 Vanguard Press